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Background and Aims: TC-325 (Hemospray, Cook Medical, Winston-Salem, NC) is an inorganic hemostatic powder recently approved by the U.S. Food and Drug Administration. This study aimed to examine the effectiveness, safety, and predictors of TC-325 failure in a large real-life cohort. Methods: This was a retrospective study conducted at 21 Spanish centers. All patients treated with TC-325 until September 2018 were included. The primary outcome was treatment failure, defined as failed intraprocedural hemostasis or recurrent bleeding within the first 30 postprocedural days. Secondary outcomes included safety and survival. Risk and predictors of failure were assessed via competing-risk models. Results: The cohort comprised 261 patients, of whom 219 (83.9%) presented with upper gastrointestinal bleeding (GIB). The most common causes were pepticulcer (28%), malignancy (18.4%), and therapeutic endoscopy-related GIB (17.6%). TC-325 was used as rescue therapy in 191 (73.2%) patients. The rate of intraprocedural hemostasis was 93.5% (95% confidence interval [CI], 90%-96%). Risks of TC-325 failure at postprocedural days 3, 7, and 30 were 21.1%, 24.6%, and 27.4%, respectively. On multivariate analysis, spurting bleeding (P = .004), use of vasoactive drugs (P = .02), and hypotension (P = .008) were independent predictors of failure. Overall 30-day survival was 81.9% (95% CI, 76%-86%) and intraprocedural hemostasis was associated with a better prognosis (adjusted hazard ratio, 0.29; P = .006). Two severe adverse events were noted. Conclusion: TC-325 was safe and effective for intraprocedural hemostasis in more than 90% of patients, regardless of the cause or site of bleeding and its use as rescue therapy. In this high-risk cohort treated with TC-325, the 30-day failure rate exceeded 25% and was highest with spurting bleeding or hemodynamic instability.

La hemorragia digestiva de origen oscuro constituye el 5-10% del total de hemorragias digestivas, siendo el intestino delgado la localización más frecuente. Por su sencillez y fiabilidad la enteroscopia con cápsula es la técnica de elección tras un primer estudio endoscópico negativo (gastroscopia e ileo-colonoscopia). Sin embargo, en ocasiones, el origen del sangrado no se identifica en el interior de éste, sino fuera y al alcance de la endoscopia convencional (esófago, estómago o colon). Presentamos el caso de un paciente de 46 años con anemia ferropénica y varios estudios endoscópicos previos negativos a quien se detectó un tumor gástrico (GIST) durante una enteroscopia con cápsula. El diagnóstico definitivo se obtuvo tras el estudio histológico de la pieza quirúrgica. Obscure gastrointestinal bleeding accounts for approximately 5-10% of patients presenting with gastrointestinal haemorrhage. The majority of lesions responsible were found to be located in the small bowel. Currently, capsule endoscopy is the first-line tool to investigate the small bowel as it is a non-invasive, feasible and simple procedure. However, capsule endoscopy sometimes identifies the source of bleeding outside the small bowel and within the reach of conventional endoscopy. We present the case of a 46 year-old man with few prior negative endoscopic procedures and iron-deficiency anaemia due to gastric GIST.

La pancreatitis autoinmune (PAI) es una patología poco frecuente, aunque con una creciente incidencia en países orientales, si bien esto podría deberse a una mayor tasa de detección. Puede asociarse a otras patologías autoinmunes, y se ha descrito su asociación con la enfermedad sistémica por IgG4. La clínica es variada y el tratamiento habitualmente es médico, mediante corticoides. Se describe un caso clínico diagnosticado. Autoimmune pancreatitis (AIP) is an infrequent pathology, although there is a growing incidence in Eastern countries, which might be due to a greater rate of detection. It can be associated with other autoimmune pathologies and its association with IgG4-related systemic disease has been described. Its clinical presentation is varied and the normal treatment is medical, using corticoids. A diagnosed clinical case is described.

Autoimmune pancreatitis (AIP) is an infrequent pathology, although there is a growing incidence in Eastern countries, which might be due to a greater rate of detection. It can be associated with other autoimmune pathologies and its association with IgG4-related systemic disease has been described. Its clinical presentation is varied and the normal treatment is medical, using corticoids. A diagnosed clinical case is described. Key words. Autoimmune pancreatitis. IgG4.

[ES] Introducción y objetivo: La cápsula endoscópica (CE) es la técnica de elección en la hemorragia de origen oscuro (HDOO). Cuando ésta recurre como hemorragia digestiva baja, es frecuente repetir la colonoscopia antes de la CE. El objetivo de este estudio es analizar el impacto de la CE en la HDOO manifestada como rectorragia (HDOO-R) y cómo puede evitar la repetición innecesaria de la colonoscopia. Material y Métodos: Presentamos un análisis descriptivo de datos recogidos prospectivamente desde enero 2009 a enero 2014. Incluimos 51 pacientes, con gastroscopia y colonoscopia previas normales, que ingresan por recidiva de la HDOO-R. A su ingreso se repitió la colonoscopia y cuando no encontró la causa se indicó la CE. Exponemos la rentabilidad de la CE y la indicación de otras técnicas tras la misma. Resultados: El éxito diagnóstico de la colonoscopia al ingreso fue del 15.7% (8/51). En los 43 casos negativos, la CE obtuvo un rendimiento del 81.4% (35/43). La lesión más frecuente fue la enteropatía erosiva. El origen de la HDOO se alcanzaba con la endoscopia convencional en el 45,7% (16/35). El resultado de la CE indicó 33 nuevas exploraciones endoscópicas (44,2% terapéuticas, 19/43) y la repetición de la colonoscopia en un 23,2% (10/43). No hubo complicaciones. Conclusiones: En nuestra experiencia, la CE es altamente rentable y segura en la HDOO-R y dirige la verdadera necesidad de nuevas exploraciones. La colonoscopia se repetirá ante persistencia del sangrado cuando la CE sea normal o ésta sospeche el origen en el colon., [EN] Background and Goals: Capsule endoscopy (CE) is the technique of choice for obscure bleeding (OGB). When it recurs in the form of lower gastrointestinal bleeding (HDB) the usual procedure is to repeat the colonoscopy before the CE. The aim of this study is to analyze the impact of CE in OGB when manifested as rectal bleeding (OGB-R) and how to avoid unnecessary repetition of the colonoscopy. Material and Methods: A descriptive analysis of data collected prospectively from January 2009 to January 2014. We included 51 patients with previous normal gastroscopy and colonoscopy, admitted for recurrent OGB-R. On their admission, colonoscopy was repeated and when the cause was not found, CE was requested. We show the effectiveness of CE and an indication of other technique safter it. Results: The success of diagnostic colonoscopy at admission was 15.7% (8/51). In the 43 negative cases, the CE yielded a performance of 81.4% (35/43). The most common injury was the erosive enteropathy. The origin of the OGB was achieved with conventional endoscopy in 45.7% (16/35). The outcome of the CE indicated 33 new endoscopies (44.2% therapeutic, 19/43) and the repetition of colonoscopy in 23.2% (10/43). There were no complications. Conclusions: In our experience, the CE is highly profitable and safe in OGB-R and addresses the actual need for new explorations. The colonoscopy will be repeated under persistent bleeding when the CE is normal or the suspected origin is in the colon.

La enteroscopia con cápsula abre una nueva era en el estudio de las enfermedades del intestino delgado. En estos momentos sus indicaciones están bien definidas y este procedimiento se ha convertido en una herramienta de primera línea en el estudio del intestino delgado. La esofagoscopia con cápsula se ha mostrado como una alternativa eficaz y segura en pacientes con sospecha de patología esofágica y en aquellos pacientes que no desean ser sometidos a una esofagoscopia convencional. No obstante y a pesar de que los resultados obtenidos hasta la fecha en pacientes cirróticos o con reflujo gastroesofágico son positivos, existen diferencias, en términos de rendimiento, entre algunos de los estudios publicados (fundamentalmente en pacientes con reflujo gastroesofágico). Estas diferencias pueden deberse al diseño de algunos estudios, a la ausencia de una adecuada experiencia con este nuevo procedimiento y finalmente, al protocolo de ingestión de la cápsula. Por todo ello, parecen necesarios nuevos estudios que incluyan series más amplias y cambios en el protocolo de ingestión de la cápsula, con el fin de confirmar los resultados obtenidos hasta la fecha. Capsule endoscopy has opened a new era in small bowel examination. Its indications are now well-defined and currently, wireless capsule endoscopy is considered as the first-line imaging tool for the diagnosis of small bowel diseases. ECE has been shown to be feasible, safe and a good alternative technique in patients refusing conventional endoscopy. Although results reported in both GERD and cirrhotic patients are encouraging, great differences in terms of accuracy (particularly in GERD patients) have been found in published studies. These differences have been attributed to study designs, the lack of adequate experience and inconvenience of ingestion protocols. In summary, more large-scale studies evaluating the new 14-fps capsule, adequate ECE-experience and new modified ingestion protocols are still needed.